My first vasectomy

It’s surprising — and a little depressing — how quickly the word “vasectomy” can turn the most urbane, Asheville-cool professional into a hawking, crotch-pulling, bad-joking, well … peckerhead. I didn’t tell a lot of folks about my impending surgical alteration, but the few I did confide in immediately underwent some psychic track-switching, trotting out a series of “jokes” and “comments” the likes of which I hadn’t heard since junior high. I began to suspect that the reason Buncombe County is overrun with unwanted mutts is the inability of your Basic Guy to differentiate between his own family jewels and those belonging to his mangy pit bull. It’s the very same impulse that equates a big car with a big … car owner. And experience suggests that this is hardly a recent development; picture an as-yet-undiscovered fragment of an ancient Athenian play in which the hero, Testacles, is boasting to a bevy of admiring maenads about his chariot’s exceptional horsepower — nudgeon, nudgeon, winkus, winkus.

That said, here’s my story.

I’m the 55-year-old, married father of a 17-year-old child by another marriage. My current wife and I, while not immune to the snuggly fantasy of offspring milling ’bout the knee, are practical enough to see that her age (42) and mine, plus our Trojan artist’s lifestyle, do not bode well for child-rearing. But yes, we’ve discussed it for years, gone back and forth, and finally arrived at some kind of resolution. We sought birth control that worked, did less hormonal meddling than the pill, and was more aesthetically and sensually pleasing than the various rubber devices available.

It can be cause for either caution or relief if your family doctor so obviously lights up when you casually mention the possibility of elective surgery. My doctor, Michael Wizeman, a G.P. with Ravenscroft Family Health Center, is a proselytizer for a technique called the No-Scalpel Vasectomy. He and his friend Dr. Donna Burkett of WNC Ob/Gyn & Family Practice learned this technique during their respective residencies in the Pacific Northwest. Moving to Asheville, they were surprised to learn that no one was offering this alternative to the more traditional scalpel and stitches — so they did.

The NSV was invented by the Chinese in the early ’70s to help manage their burgeoning population.

For the Chinese, a cheaper, faster and equally effective birth-control technique was just what the doctor ordered, and the fact that it could be performed by technicians rather than the doctor was an additional plus. (The female equivalent of the vasectomy — the tubal ligation — is more invasive and risky, about one-third as effective, and more expensive.) “The nice thing about a vasectomy,” says Dr. Burkett, “is that you can test to see that it worked, which you can’t do with a tubal ligation.” Sperm is either in the semen or it’s not; none of this hide-and-seek egg behavior.

In a vasectomy, a section is cut out of the vas deferens (the spaghetti-sized tube that carries sperm from the testicles to the prostate, where it’s mixed with semen prior to delivery). One or both ends of the vas are then cauterized to prevent an overachieving sperm from leaping the void and surprising an unexpectant mother. The only difference between an NSV and a conventional vasectomy is the way the surgeon accesses the vital parts. A urologist performs the conventional vasectomy as an outpatient procedure; an incision is made in the scrotum, the two vasa deferentia are pulled out and severed, along with any innocent nerves and blood vessels that lie too close to the action. The ends are cauterized and the incision stitched up.

In the No-Scalpel Vasectomy, a small puncture is made in the center of the scrotum, each vas is pulled out with a crochet-hooklike tool, severed and cauterized and allowed to snap back into the scrotum. No stitches are required, the puncture heals on its own, and the incidence of nerve and vessel damage is greatly reduced.

“The NSV is less invasive and has fewer complications than the traditional techniques,” Wizeman reports. Complications can include swelling, bruising, post-operative pain, and numbness of the scrotum. Sometimes the little lost sperms can cluster together in the scrotum and create a “sperm granuloma” — a benign sperm tumor.

So, armed with knowledge, an enthusiastic doctor, a supportive wife, and a $25 co-pay for an office procedure, I did the deed. My biggest disappointment was the lack of decent drugs — just a local anesthetic and a Lorazepam (neo-Valium) that was about as strong as a shot of gin. I showed up at the office Friday morning — the only day Wizeman performs the operation (to give his patients the whole weekend to recover). Once in the doctor’s office, I stripped to the waist, lay back on the table, and surrendered my body to the doctor and an assistant. The whole thing took about 15 minutes; there was some little tugging pain, I got to see what my vas looks like, and then I pulled up my pants and was out the door.

Old habits die hard. It takes about three months for the sperm to clear out of the delivery system, so old practices must be continued until the doctor gives the all-clear. After that, feed me a little Viagra and I’m ready to join the ranks of mainstream, sexually overactive hetero-seniors.

More than 500,000 vasectomies are done in the United States each year, the Digital Urology Journal reports. According to Cornell University, more than 15 million men around the world have had NSVs, two-thirds of them in China. In the ’80s, follow-up exams done there found only minor complications — and those in less than 1 percent of cases.

With conventional vasectomies, the rate of complications runs around 3 percent.

Dr. Dane Weil of Asheville Urological Associates says vasectomies are their most commonly done procedure, ahead of prostate cancers and kidney stones. The four doctors at AUA perform about 500 vasectomies a year, all NSVs. The average patient is in his early 30s, and about 90 percent are married. “We get some divorced men who are getting back into the scene,” said Weil. Dan Keller at Victoria Urological Associates, the other big practice in Asheville, says their five doctors perform 250 to 300 vasectomies a year. They, too, do mostly NSVs. “It’s pretty much industrywide now,” notes Keller.

Wizeman and Burkett, meanwhile, have each done about 35 NSVs in Asheville during the last year-and-a-half. They also teach the procedure to residents from the Mountain Area Health Education Center.

“It’s a beautiful gift for a man to give his wife,” says Burkett.

“It takes the burden of birth control off the woman. The guy leaves happy, the wife leaves happy. It’s a procedure I enjoy doing as much as I enjoy baking bread.” Intrigued, I asked her to elaborate on that final statement.

“I’ve accomplished something for a person, and I’ve used my fine-motor skills — something a G.P. doesn’t do every day — and I’ve used a skill which I am proud of.”

I’m not a particularly sentimental person. But as I lay on the couch that afternoon, afloat on my ginlike high, I had a daydream of a shadowy little fellow — the child we might have had — looking over his shoulder sadly before disappearing into the gloom of what was not to be.

All choices have consequences: the road left untraveled. But the prime directive of humans — to procreate — is diminished by the din of an overpopulated world in which people of my class and nationality take a bigger bite than 10 of the rest. From this particular couch, anyway, more breeding seems the self-indulgent course, and choosing birth control seems both responsible and generous. So on your way, little fellow, on your way…

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